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Bulletin September 2011

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Bulletin September 2011 SEPTEMBER 2011 Volume 96, Number 9 INSPIRING QUALITY: Highest Standards, Better Outcomes FEATURES Stephen J. Regnier Editor ACS launches Inspiring Quality tour in Chicago 6 Lynn Kahn Tony Peregrin Director, Division of Integrated Communications Hospital puts ACS NSQIP® to the test and improves patient safety 9 Scott J. Ellner, DO, MPH, Hartford, CT Tony Peregrin Senior Editor Is there a role for race in science and medicine? 12 Diane S. Schneidman Dani O. Gonzalez; Linda I. Suleiman; Gabriel D. Ivey; Contributing Editor and Clive O. Callender, MD, FACS Tina Woelke ACS eases the pain of providing palliative care 19 Graphic Design Specialist Diane S. Schneidman Charles D. Mabry, Accountable care organizations: A primer for surgeons 27 MD, FACS Ingrid Ganske, MD, MPA; Megan M. Abbott, MD, MPH; Leigh A. Neumayer, and John Meara, MD, DMD, FACS MD, FACS Marshall Z. Schwartz, MD, Governors’ Committee on Surgical Infections and Environmental Risks: FACS An update 36 Mark C. Weissler, Linwood R. Haith, Jr., MD, FACS, FCCM MD, FACS Editorial Advisors Tina Woelke Front cover design DEPARTMENTS Future meetings Looking forward 4 Editorial by David B. Hoyt, MD, FACS, ACS Executive Director Clinical Congress 2011 San Francisco, CA, HPRI data tracks 38 October 23-27 Geographic distribution of general surgeons: Comparisons across time and specialties Simon Neuwahl; Thomas C. Ricketts, PhD, MPH; and Kristie Thompson 2012 Chicago, IL, September 30– Socioeconomic tips 42 October 4 Coding hernia and other complex abdominal repairs 2013 Washington, DC, Christopher Senkowski, MD, FACS; and Jenny Jackson, MPH October 6–10 State STATs 45 Graduated driver licensing: Keeping teen drivers safe Letters to the Editor should be Alexis Macias sent with the writer’s name, ad- dress, e-mail address, and daytime telephone number via e-mail to [email protected], or via mail to Stephen J. Regnier, Editor, Bulle- tin, American College of Surgeons, 633 N. Saint Clair St., Chicago, IL 60611. Letters may be edited for length or clarity. Permission to publish letters is assumed unless the On the cover: Surgeons and other health care providers are stepping forward to lead quality author indicates otherwise. improvement efforts, as demonsrated by the College’s Inspiring Quality initiative and the growth of the ACS National Surgical Quality Improvement Program (see articles, pages 6 and 9). NEWS Bulletin of the American College of Surgeons (ISSN In memoriam: 0002-8045) is published monthly C. Rollins Hanlon, MD, FACS, remembered 47 by the American College of Sur- David L. Nahrwold, MD, FACS geons, 633 N. Saint Clair St., Chicago, IL 60611. It is distrib- Layton Rikkers, MD, FACS, uted without charge to Fellows, Associate Fellows, Resident and named Editor-in-Chief of Surgery News 53 Medical Student Members, Af- filiate Members, and to medical New Director of Integrated Communications announced 55 libraries and allied health person- nel. Periodicals postage paid at Official Notice: Annual Businesseeting M of Members, Chicago, IL, and additional mail- American College of Surgeons 55 ing offices. POSTMASTER: Send address changes to Bulletin of the Rural surgery symposium and skills course held in Chicago 56 American College of Surgeons, Stephen J. Regnier 3251 Riverport Lane, Maryland Heights, MO 63043. Canadian Can you identify old photos in the ACS Archives? 64 Publications Mail Agreement No. 40035010. Canada returns to: $750,000 grant funds physician shortage tracking tool 65 Station A, PO Box 54, Windsor, ON N9A 6J5. Managing the transition between The American College of clinical and nonclinical roles to be addressed at Congress 65 Surgeons’ headquarters is lo- cated at 633 N. Saint Clair St., ACOSOG news: ACOSOG in ACTION 67 Chicago, IL 60611-3211; tel. Heidi Nelson, MD, FACS; David M. Ota, MD, FACS; 312-202-5000; toll-free: 800- Monica M. Bertagnolli, MD, FACS; and Jan Buckner, MD 621-4111; e-mail:postmaster@ facs.org; website: www.facs. Did you know... 68 org. Washington, DC, office is located at 20 F Street N.W. Suite A look at The Joint Commission: 1000, Washington, DC. 20001- 6701; tel. 202-337-2701; web- TJC Center takes on wrong site surgery prevention 70 site: www.tmiva.net/20fstreetcc/ home. Letters 72 Unless specifically stated oth- ® erwise, the opinions expressed NTDB data points: and statements made in this Precious cargo 75 publication reflect the authors’ Richard J. Fantus, MD, FACS; and Blaine Stringer, RN, BSN personal observations and do not imply endorsement by nor official policy of the American College of Surgeons. ©2011 by the American College of Surgeons, all rights reserved. Contents may not be reproduced, stored in a retrieval system, or transmitted in any form by any means without prior writ- ten permission of the publisher. Library of Congress num- ber 45-49454. Printed in the USA. Publications Agreement No. 1564382. The American College of Surgeons is dedicated to improving the care of the surgical patient and to safeguarding standards of care in an optimal and ethical practice environment. Looking forward ost of us would agree that surgery is one of the most intellectually, physically, and emotionally challenging professions one could choose. In fact, many of us Mbecame surgeons because we were confident that we were smart enough, energetic enough, and strong ’’ enough to meet those demands and still have fulfilling personal lives. As we mature, we often find ourselves humbled at the realization that we have limitations. Nonetheless, our passion for excellence and for patient care drives us to keep pushing through and demand- ing the best of ourselves and our colleagues. Dr. Scott-Conner’s personal Understanding surgeons story and the ones she tells in Few people outside of our profession truly seem to understand why we take on these pressures, let alone A Few Small Moments convey the surgeon’s psyche and culture. The arrogant, unfeel- ing, adrenaline- and ambition-fueled surgeons often the daily challenges that all depicted in novels, television programs, movies, and other media are what most people know. surgeons—young and old, male These characters are often created by individuals who have had limited contact with actual surgeons. As and female—experience. a result, the public often has a distorted image of us. So, it is refreshing to occasionally come across a piece of fiction that is written by a surgeon, who is more likely to present us as we truly are—warts and ’’ all. I recently had the pleasure of reading A Few Small Moments, a collection of short stories written by Carol Scott-Conner, MD, FACS. A look inside All of the stories in A Few Small Moments center on the character of Beth Abernathy, a cancer surgeon at a Midwestern teaching hospital who is entering her sixth decade of life. Dr. Scott-Conner’s stories portray surgeons as complex, intelligent, highly motivated, and caring people who sometimes grow frustrated with our own limitations and with the constraints of the environment in which we work. As chair of surgery at her institution, Dr. Abernathy sometimes must confront a surgeon who is exhibiting unprofessional behavior and poor responses to stress. When, at one point, she finds herself exploding and acting out in the face of her own perceived failure to adequately evaluate a patient’s condition, Beth realizes that, “Unbridled anger is the Achilles heel of surgeons like us.” She sees some of herself in the younger, more reckless surgeon and offers to help her find ways of changing her behavior. 4 Chairs of surgery also must deal with their insti- VOLUME 96, NUMBER 9, BULLETIN OF THE AMERICAN COLLEGE OF SURGEONS tutions’ internal politics, financial issues, and other female—experience. She reinforces the importance of administrative burdens. They must answer to deans, being willing to lean on our families and colleagues who are more deeply entrenched in the administra- when work overwhelms us, of taking a realistic assess- tive mindset. Beth believes she is increasingly pulled ment of our goals and capabilities, and of listening to in three different directions, needing to devote large our patients. This book truly provides fresh insights shares of her time and energy to patient care, teach- into what makes us tick and why we are so committed ing and writing, and meetings. She thinks about early to our pursuit of surgical excellence. retirement or stepping down from the chairmanship and rededicating herself to seeing patients and teach- ing. Ultimately she chooses to continue practicing be- cause, despite the headaches, she knows she is a good surgeon and a competent teacher who really enjoys surgery. Working with even the most difficult patients, who engage in the most self-destructive behaviors, David B. Hoyt, MD, FACS provides her with new opportunities to learn and grow as a professional and as a person. Watching surgical residents develop new skills and providing them with guidance brings its own rewards. Beth develops deeper empathy for her patients when she experiences atrial fibrillation and must be admitted into the cardiac unit at her institution. She learns what it means to feel vulnerable and to allow another human being to take control of your life, what it’s like to recuperate slowly, but steadily. A dynamic profession The book closes with a short recitation on “the making of surgeon,” in which Dr. Scott-Conner ties the underlying message of each story together and aptly describes the true character of most surgeons. She notes, “When we recommend surgery and take a patient to the operating room, we change that person’s life forever, most often for the better. We live in a very real way with our successes and our occasional failures.” We need to be able to work under incred- ible pressure and maintain a sense of optimism and a high energy level.
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